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The question: I recently had an awful belly pain and was seen in the emergency room. I was diagnosed with a gallbladder attack and sent home with an appointment to see a surgeon to discuss possible surgery to remove my gallstones. I'm a 30-year-old male and very healthy – why did this happen and is it really necessary to have surgery?

The answer: This is a common concern and you are not alone: About 20 per cent of Canadian women and 10 per cent of men have gallstones by the age of 60. Risk factors for gallstones include being overweight, having diabetes, pregnancy, consuming too much animal fat and not enough fibre, and rapid weight loss from dieting or bariatric surgery. But despite these well established risk factors, gallstones can still happen – as in your case – to those who are otherwise healthy.

In order to prevent, manage or treat the condition, it's important to look at what the gallbladder does and how gallstones are formed.

The gallbladder is a small pear-shaped sac that is tucked under the liver. Due to its small size, it's often not an organ that we think about until it starts causing us pain. The gallbladder stores bile, a fluid produced in the liver, that breaks down fat. When we eat food that contains fat, the gallbladder contracts and releases the bile into the intestine.

Over time, digestive juices can harden and form stones in the gallbladder. For most, gallstones do not cause symptoms and are incidentally discovered while looking for something else either on a CT scan or ultrasound. If you have no symptoms, it is best to leave your gallbladder and the stones alone.

However, if a gallstone gets lodged and blocks the flow of bile, you can develop symptoms such as pain in the upper right part of the abdomen due to inflammation of the gallbladder (cholecystitis). The pain can feel colicky in nature and can be accompanied by nausea or vomiting, pain in the back or right shoulder, and in more severe cases, fever or a yellowing of the skin (jaundice).

When you do have symptoms, it is important to consider removing the gallbladder or take medication that can break down the stones. Given that you are a healthy young male, the best course of action would probably be surgery to prevent further episodes. You can try to manage your symptoms by maintaining a healthy body weight and eating less fatty foods, but keep in mind that over time there is an increased risk of repeat inflammation. This can be very painful and may lead to a more serious infection and formation of scar tissue. Another potential complication of gallstones is blockage of the ducts in the pancreas which can lead to pancreatitis.

Surgery is the most definitive treatment because once the gallbladder is removed, gallstones do not recur. Most surgery is done using a technique called laparoscopy. The surgeon uses a camera to look inside and makes a small cut to the abdomen instead of fully opening the area. This procedure is less invasive and often people get to go home the same day or the next morning. In some cases, an open surgery is needed if the gallbladder is too big or there is too much scar tissue to safely do the procedure laparoscopically.

For those that cannot tolerate surgery due to age or other medical issues that make it dangerous, medication can be taken to break down the gallstones. Keep in mind that these medications can take months or years to work and there is a high risk of recurrence when they are stopped.

Meeting with the surgeon does not automatically mean that you will have surgery. It is understandable to have some trepidation, so use your appointment as an opportunity to discuss these questions and concerns to find out what action is best for you.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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